Legal and ethics considerations in reporting sexual exploitation by previous providers

When a patient reports a sexual relationship with a prior provider during treatment, a psychiatrist or therapist must balance conflicting ethics principles of autonomy, confidentiality, and social justice in deciding whether to report this behavior to the proper authority. Many states have statutes regarding such reporting that are unclear or ambiguous; others lack laws entirely. We surveyed state laws and contacted state medical boards to clarify each state’s position on mandatory reporting of sexually exploitive psychiatrists, specifically when the patient reveals the exploitation during treatment. Our results showed that only 5 state legislatures have explicitly addressed this matter. Of the remaining states, 18 require reporting through a patchwork of laws and policies, and the other 27 states and the District of Columbia have no laws that require reporting a colleague if a patient discloses a past sexual relationship. In this article, we examine the different approaches and considerations taken by state legislatures and medical boards in addressing this concern.